As the healthcare system shifts from a focus on employee-based plans to consumer-based plans, insurers have to find new ways to engage and motivate members.
One of the most effective strategies plans and providers should consider is personalization.
That’s according to Neal Sofian, MPH, MSPH, director of member engagement at Premera Blue Cross, and Jordan Mauer, executive vice president of marketing and member engagement at NovuHealth, a member engagement services provider. They discussed personalization strategies at the 7th Annual HEDIS & Quality Improvement Summit in Miami on October 17.
“For the first time, as we move away from purely employer-based insurance [and] consumers have more of a say in the payment and the insurance they get, [health plans] are on the hook for some of this stuff,” Sofian says, adding that
50% of all healthcare costs and 70% of chronic care costs are tied to lifestyle choices and behaviors.
New approach needed
Traditionally, plans have segmented populations and reached out through methods such as direct mailings, offering members facts about their condition and what they need to do to make positive changes. But, Sofian says, these strategies fail.
“We’ve taken an approach that if we give people the facts they will make changes,” Sofian says. “But that doesn’t work. There’s a lot of research about what actually motivates health change and it’s things around what enables us to make change.”
People make changes based on their values, what’s most important to them, and what their habits are, he says. To effect change, plans need to understand what their members value and reach out to them in that context, he says.
“We have to learn to tailor programs to what fits in lifestyles and how people want to use it,” Sofian says.
Other industries have used personalization based on lifestyle choices and preferences to increase consumer engagement, and the technology is there to make it easier than ever. But legal and privacy challenges have hampered these efforts in healthcare, and the system is not set up to reward members for making positive changes.
“We have not built a business model around people actually taking care of themselves,” Sofian says. “The system is set up to make money when people get sick, not by keeping them healthy. There’s been a division between the people who pay and the people who benefit. The whole system is designed really to not encourage people doing the right thing and everybody—lawyers, pharma, doctors, and consumers—is to blame.”